title: The influence of symptoms, social support, uncertainty, and coping on health-related quality of life among cholangiocarcinoma patients in northeast Thailand.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) is an important outcome for evaluating the effectiveness of cancer care. Cholangiocarcinoma (CCA) is a major public health problem in northeast Thailand. There is little information regarding factors influencing HRQOL in CCA patients. Understanding the factors affecting HRQOL in CCA patients is necessary to develop nursing interventions to improve the HRQOL.
  
  
  OBJECTIVE
  The purpose of this study was to develop and test a model that explained the influence of symptoms, social support, uncertainty, and coping on the HRQOL in CCA patients.
  
  
  METHODS
  Using a cross-sectional descriptive design, a convenience sample of 260 CCA patients were consecutively recruited from a regional hospital and a university hospital in northeast Thailand. All participants responded to a set of 6 questionnaires in structured interview format. A linear structural relationship was used to test the hypothesized model.
  
  
  RESULTS
  Findings revealed the hypothesized model fit the empirical data and explained 69.4% of the variance of HRQOL. Symptoms were the most influential factor affecting HRQOL directly and indirectly through uncertainty. Social support had a direct effect on HRQOL and an indirect effect on HRQOL through uncertainty. Uncertainty had a direct effect on coping and HRQOL. Coping had a nonsignificant direct effect on HRQOL.
  
  
  CONCLUSIONS
  Symptoms, social support, and uncertainty were important factors influencing HRQOL in CCA patients.
  
  
  CONCLUSIONS
  Cholangiocarcinoma is a unique yet understudied condition. Further work in developing CCA-specific HRQOL interventions is warranted.
authors.affiliation: Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Busaba
authors.initials: B
authors.lastname: Somjaivong
authors.forename: Sureeporn
authors.initials: S
authors.lastname: Thanasilp
authors.forename: Sunida
authors.initials: S
authors.lastname: Preechawong
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sloan
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000503:physiopathology* / Q000523:psychology; D001653:Bile Ducts, Intrahepatic / Q000503:physiopathology*; D018281:Cholangiocarcinoma / Q000503:physiopathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D013785:Thailand; D035501:Uncertainty